SSAT - OVERALL SURVIVAL AFTER PANCREATICODUODENECTOMY WITH PORTAL VEIN RESECTION FOR MACROSCOPICALLY INFILTRATING PANCREATIC CANCER

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OVERALL SURVIVAL AFTER PANCREATICODUODENECTOMY WITH PORTAL VEIN RESECTION FOR MACROSCOPICALLY INFILTRATING PANCREATIC CANCER
Ramez Wahib^*, Michael F. Nentwich, Matthias Reeh, Pasquale Scognamiglio, Florian Gebauer, Maximilian Bockhorn, Jakob R. Izbicki, Dean Bogoevski
General,- Visceral and Thoracic Surgery , University Hospital Hamburg Eppendorf, Hamburg, Hamburg, Germany

Background:
To assess the survival rates after en bloc portal vein resection (VR) for infiltration in pancreatic malignancies.
Methods:
Between January 2010 and December 2012, a total of 279 patients with pancreatic adeno carcinoma of the pancreas head were operated at the University Clinic Hamburg Eppendorf. 61 patients underwent a portal vein segment resection by macroscopic infiltration as a part of an oncological pancreatic resection for pancreatic cancer (Whipple n=48, total duodenosplenopancreatectomy n=13).
Results:
Sixty-one patients underwent portal or superior mesenteric vein resection (VR). In-hospital morbidity and mortality rates of VR patients (37.9%/4.92%) nearly equaled that of patients without portal or superior mesenteric vein resection (40.3%/3.7%).
An invasion of the portal vein wall was histologically proven in 26 patients, whereas in the other 35 patients the portal vein specimens were tumor free and a peritumoral inflammation was found.
Median survival was 14.96 months (4.7m-59.34m) in patients with histologically proven vein invasion (VR+) and 13.85 months (6.59m-55.86m) in those without (VR-) (p = 0.337). Two-year survival probabilities were 27.27% in patients without vascular invasion (VR-) versus 33.33% with vascular invasion (VR+); (p = 0.29). Among VR+ patients with histologically evidenced vascular invasion, 6 patients survived longer than 48 months.
CONCLUSION: Postoperative morbidity and mortality rates after en bloc portal resection are comparable with "standard" pancreatectomy procedures. Median survival of 15 months in patients with vascular invasion is superior to that of patients who undergo palliative therapy and nearly equals that of patients who are not in need for portal vein resection.

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